Telemedicine in Pediatric Cardiology Gary Satou, Sanket Shah, Craig Sable Abstract Pediatric cardiology is one of the most prevalent applications of telemedicine Multiple publications support that tele-echocardiography is accurate and diagnostic, improves care, appropriately triages patients, prevents unnecessary transports, is cost-effective, and improves sonographer proficiency and physician efficiency Evolving technology allows for seamless integration of tele-echocardiography into routine practice, making it the standard of care Near-universal adoption of newborn pulse oximetry screening for critical congenital heart disease mandates a renewed focus on telemedicine for many delivery hospitals in the United States Telemedicine also impacts many other areas of pediatric cardiology with innovative solutions for fetal medicine, outpatient cardiology, electrophysiology, intensive care unit, home monitoring, direct to consumer telemedicine, global health, and patient care and education conferences Removal of reimbursement, licensure, and credentialing obstacles is needed to realize the full benefit that telemedicine can have for pediatric cardiology patients and on the health care system in general Keywords Telemedicine; echocardiography; remote monitoring Telemedicine now pervades almost every aspect of the practice of pediatric cardiology Simply defined, telemedicine means using technology to practice medicine at a distance–and it is now used on a daily basis for clinical care, education, research, and administrative tasks.1 Use of the cloud to transfer images (echocardiogram, angiography, computed tomography [CT], or magnetic resonance imaging [MRI]), remote attendance at patient care conferences, home monitoring of interstage single-ventricle patients, wearable devices for rhythm detection, and remote login to view monitor tracings for intensive care unit patients are all examples of telemedicine This technology is now accessible on smart phones and tablets, and most users could not imagine practicing medicine without it This chapter provides an overview of how tele-echocardiography and other modalities of telemedicine are used in pediatric cardiology, with a focus on how technology and clinical use have evolved Echocardiography Telemedicine has become the standard of care in pediatric echocardiography Tele-echocardiography can be carried out via live videoconference in real time or as store-and-forward images to be viewed remotely Initial telemedicine studies utilized point-to-point Integrated Services Digital Network (ISDN) and Terrestrial-1 connections for live telemedicine with good image quality and acceptable temporal resolution (frame rates of 23 to 30/second).2–8 Rapid progression of technology over the last 10 years has made this technology obsolete Today, Internet Protocol (IP) allows for multipoint network connectivity that enables use of codecs or videoconferencing software from anywhere on any device These include room systems, desktop or laptop computers, tablets, and smart phones The field of pediatric tele-echocardiography has predominantly evolved into store-and-forward solutions that, in many cases, are extensions of existing echocardiography picture archiving and communication systems (PACs) with special considerations for data transfer Direct point-to-point study transmission options include secure file transfer protocol (FTP) and virtual private network (VPN) Cloud servers enable transmission of and access to echocardiograms from anywhere in the world with subsequent download into local PACs servers.9,10 Many physicians access echocardiograms via remote connection to PACs networks through client or web-based programs In our hospitals, we have a mix of all of these technologies, but we prefer that studies be transferred into our PACs system for uniform interpretation and reporting However, some partner hospitals insist on us reporting in their local PACs and electronic medical records Diligent attention to security, licensure, and credentialing requirements, and compliance issues as well as a need for 24/7 technical support staff are critical for maintenance of a successful tele-echocardiography network Multiple studies have found neonatal tele-echocardiography to be accurate and cost-effective, have a positive impact on patient care, prevent unnecessary transports, and improve sonographer proficiency.3,4,6,11–16 Table 91.1, modified from a recent scientific statement from the American Heart Association, provides a summary of several of these studies.1 When not diagnosed prenatally, newborns with congenital heart disease are often delivered, or present to a primary care setting, where expert cardiovascular evaluation may not be ... the United States Telemedicine also impacts many other areas of pediatric cardiology with innovative solutions for fetal medicine, outpatient cardiology, electrophysiology, intensive care unit, home monitoring, direct... other modalities of telemedicine are used in pediatric cardiology, with a focus on how technology and clinical use have evolved Echocardiography Telemedicine has become the standard of care in pediatric echocardiography... Removal of reimbursement, licensure, and credentialing obstacles is needed to realize the full benefit that telemedicine can have for pediatric cardiology patients and on the health care system in general Keywords Telemedicine; echocardiography; remote monitoring